Prevalence and Overlap of Potential Embolic Sources in Patients With Embolic Stroke of Undetermined Source
Date
2019Language
en
Sujet
Résumé
Background: We aimed to assess the prevalence and degree of overlap of potential embolic sources (PES) in patients with embolic stroke of undetermined source (ESUS). Methods and Results: In a pooled data set derived from 3 prospective stroke registries, patients were categorized in ≥1 groups according to the PES that was/were identified. We categorized PES as follows: atrial cardiopathy, atrial fibrillation diagnosed during follow-up, arterial disease, left ventricular disease, cardiac valvular disease, patent foramen ovale, and cancer. In 800 patients with ESUS (43.1% women; median age, 67.0 years), 3 most prevalent PES were left ventricular disease, arterial disease, and atrial cardiopathy, which were present in 54.4%, 48.5%, and 45.0% of patients, respectively. Most patients (65.5%) had >1 PES, whereas only 29.7% and 4.8% of patients had a single or no PES, respectively. In 31.1% of patients, there were ≥3 PES present. On average, each patient had 2 PES (median, 2). During a median follow-up of 3.7 years, stroke recurrence occurred in 101 (12.6%) of patients (23.3 recurrences per 100 patient-years). In multivariate analysis, the risk of stroke recurrence was higher in the atrial fibrillation group compared with other PES, but not statistically different between patients with 0 to 1, 2, or ≥3 PES. Conclusions: There is major overlap of PES in patients with ESUS. This may possibly explain the negative results of the recent large randomized controlled trials of secondary prevention in patients with ESUS and offer a rationale for a randomized controlled trial of combination of anticoagulation and aspirin for the prevention of stroke recurrence in patients with ESUS. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02766205. © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Collections
Related items
Showing items related by title, author, creator and subject.
-
Left atrial diameter thresholds and new incident atrial fibrillation in embolic stroke of undetermined source
Perlepe K., Sirimarco G., Strambo D., Eskandari A., Karagkiozi E., Vemmou A., Koroboki E., Manios E., Makaritsis K., Vemmos K., Michel P., Ntaios G. (2020)Background and purpose: We analyzed consecutive patients with embolic stroke of undetermined source (ESUS) from three prospective stroke registries to compare the prognostic performance of different LAD thresholds for the ... -
Data-driven machine-learning analysis of potential embolic sources in embolic stroke of undetermined source
Ntaios G., Weng S.F., Perlepe K., Akyea R., Condon L., Lambrou D., Sirimarco G., Strambo D., Eskandari A., Karagkiozi E., Vemmou A., Korompoki E., Manios E., Makaritsis K., Vemmos K., Michel P. (2021)Background and purpose: Hierarchical clustering, a common ‘unsupervised’ machine-learning algorithm, is advantageous for exploring potential underlying aetiology in particularly heterogeneous diseases. We investigated ... -
Embolic Stroke of Undetermined Source and Detection of Atrial Fibrillation on Follow-Up: How Much Causality Is There?
Ntaios G., Papavasileiou V., Lip G.Y.H., Milionis H., Makaritsis K., Vemmou A., Koroboki E., Manios E., Spengos K., Michel P., Vemmos K. (2016)Background There is increasing debate whether atrial fibrillation (AF) episodes during follow-up in patients with embolic stroke of undetermined source (ESUS) are causally associated with the event. AF-related strokes are ...